Physiotherapy after hip prosthesis

Physiotherapy should start on the 1st day after hip arthroplasty and should continue for 6-12 months to restore normal hip movement, maintain strength and range of motion, decrease pain, prevent the onset of complications such as displacement of the prosthesis or clot formation and prepare to return to daily activities.

Among the exercises used for rehabilitation after hip arthroplasty are: stretching, active exercises, strengthening, proprioception, gait training and hydrotherapy. But electrotherapy resources such as tension, ultrasound and short waves, as well as ice packs to control pain and inflammation can also be used.

Exercises after hip prosthesis

Exercises after hip prosthesis should be guided by the physiotherapist because they can vary from one person to another, according to the type of prosthesis used. They serve to strengthen the muscles, improve the movement of the hips and increase blood circulation, preventing the formation of clots. Some examples of exercises that the physiotherapist can indicate are:

In the first days

• Exercise 1: Lying down, move your feet up and down, keeping your legs straight, for about 5 to 10 seconds Exercise 2: Slide the heel of the operated leg towards the butt, bending the knee, no more than 90º, keeping the heel on the bed Exercise 3: Do the bridge exercise by raising the hip of the bed Exercise 4: Press the thigh muscles against the bed, keeping the knees straight for about 5 to 10 seconds Exercise 5: Elevate the operated leg, up to 10 cm away from the bed, keeping it stretched Exercise 6: Place a ball between your knees and press the ball, strengthening the adductor muscles

From the 2nd week

After discharge, when returning home, it is important to continue doing the exercises under the supervision of the physiotherapist. As the person gains more strength, less pain and limitation, other exercises can be introduced, such as:

• Exercise 1: Leaning on a chair, stretch the knee of the operated leg, not exceeding the hip height, for 10 seconds Exercise 2: Standing, supported on a chair, raise the leg with the prosthesis, not exceeding the hip height Exercise 3: Standing on a chair, lift the leg with the prosthesis back and return to the starting position, without moving your hips

From 2 months

• Exercise 1: Walking (on the support bar) for 10 minutes Exercise 2: Walking (on the support bar) backwards for 10 minutes Exercise 2: Squats with the ball against the wall Exercise 4: Step or exercise bike on a high bench

These exercises help to maintain strength and range of motion, strengthen muscles, accelerate recovery and prepare for a return to daily activities. However, other exercises can be performed, as needed. The exercises should be done 2-3 times a day and in case of pain, the physiotherapist can use cold compresses at the end of the treatment.

From 4 months

Exercises can progress, becoming more difficult, with 1.5 kg shin guards in addition to gait training, resistance bike, proprioception on the trampoline and bipedal balance. Other exercises like mini trot, mini squats can also be performed.

From 6 months

You can increase the load progressively as the exercises become easier. The weight of 3 kg on each ankle must already be tolerated, in addition to short runs with sudden stops, jumps and leg presses.

Exercises in the water

Water exercises can be performed 10 days after surgery and can be performed in a hydrotherapy pool with water at chest height, and water temperature between 24 and 33ºC. Thus, it is possible to have a relaxation and decrease in muscle spasm, up to an increase in the pain threshold, among other benefits. Small floating equipment can be used, such as halter, cervical collar, palm, shin and board.

Stretches

Stretching exercises can be performed from the 1st postoperative day, passively, with the help of the physiotherapist. Each stretch should last from 30 seconds to 1 minute and are important to maintain the range of motion. Stretching is recommended for all muscle groups in the legs and glutes.

When to walk freely again

Initially the person needs to walk using crutches or a walker, and the time varies according to the type of surgery performed:

• Cemented prosthesis: stand without support after 6 weeks of surgeryCementless prosthesis: stand and walk without help after 3 months of surgery.

When standing without support, muscle strengthening exercises should be performed, such as mini squats, resistance with an elastic band and low weight anklets. It increases progressively with unilateral support exercises, such as climbing stairs.